The EHR is a tool which may contribute to the quality of the community residents’ healthcare. By using the EHR, primary health care providers can better understand the changing health status of their communities, track and respond to trends in illness and provide timely and appropriate interventions . Also, the EHR can help doctors review patient’s condition, contributing to better diagnosis and consistent treatment of the disease. Complete and accurate electronic health records can improve the efficiency and quality of clinical practice . A study in Washington, USA found that use of the EHR could save 40% of health care practitioners’ time compared with paper records to get the same information . At present, in developed countries such as Australia, Netherlands and UK, the coverage rates of EHR are over 90%, but the use and sharing of records between services is not generally high [10–13]. China faces a similar challenge .
There may be multiple reasons why medical staff in China are reluctant to use the EHR [4, 14, 15]. Three are especially important for rural doctors. The first is that many older doctors lack the computer knowledge and skill to operate the EHR system effectively. The second is that doctors are often unaware of the assistance that EHR can provide in improving the quality and efficiency of their work. The third is that, when doctors record all health service information into EHR, this exposes their own practices to greater scrutiny by other doctors and government officials . These are difficult but important problems to address. In less developed areas, the research on the EHR has been focused on the knowledge, attitudes and satisfaction of medical personnel and patients with EHR. There are only a limited number of descriptive of her use in China. Most of this did not evaluate use before and after an intervention and involve a control group [15, 17, 18]. This study extends and complements previous research.
Public health records
In our study, training and support of village doctors in the use of the EHR was associated with improved recording of basic health information, health examination, health education, vaccination, child health management and elderly health care. In the intervention program, project team members explained the basic public health services policy and funding programs to village doctors in order to help them understand the importance of public health work in rural areas, provided technical guidance to them using EHR to record public health services, removed barriers for village doctors carrying out the EHR work and motivated them in the use of the EHR. A descriptive survey of EHR use in five counties in Henan province showed that the proportion of complete basic personal information and vaccinate records were 5.1% and 18.3% respectively . These are similar to the baseline results of this study. After the intervention, the proportion of complete basic personal information and vaccinate records increased significantly in intervention group.
Health examination and the elder health management
Health examination and the elderly health management records improved both in intervention group and control group. This may have been caused by another Chongyi county government program which regularly organized residents to have physical examinations and arranged for the results to be entered into the EHR.
Basic clinic records
There was some improvement in basic clinic records in the intervention group but not in control group. At present, due to limited national investment in public health, private village clinics (CHSS) rely on patient payments as their main source of income. After the implementation of national essential drug system but before subsidies for no profit on the sale drugs, the vast majority of village doctors’ medical income came from the sale of drugs. This left village doctors using EHR to carry out basic medical services in a conflicted situation. On the one hand, they wanted to make full use of the EHR as an effective tool to carry out routine medical work, thereby improving the operational level and the quality of work. On the other hand, if complete, comprehensive and standardized basic clinic information was updated into EHR, their medical business practices would be exposed to scrutiny by other village doctors, medical experts at the county level, and government administrators. In such a contradictory situation, the vast majority of village doctors chose to not use the EHR to comprehensively record basic medical services. Our intervention was able to overcome some but not all of these problems by demonstrating how the net effect of using the EHR could be positive.
Strengths and limitations
The gender and age of residents and doctors in the intervention and control groups before and after the intervention were similar and did not change significantly. The two groups of adjacent CHSS were also similar with respect to their economic and social conditions and the doctors’ service population reducing the confounding effects of these on the comparative analysis between the intervention and control groups.
This study was conducted with a relatively small sample of households in one rural county and thus the findings should be generalized to other areas with caution. Only a limited number of aspects of the recording of public health and general medical service provision could be examined in this study. It would be useful to replicate the study in other rural areas, possibly using a cluster randomized controlled trial methodology.